About Those Medicare “Cuts”

Even as would-be Medicare voucherizer (or “premium supporter,” if you prefer) Paul Ryan has joined the ticket and made his budget its agenda, the Romney campaign seems to have intensified what may be compensatory efforts to claim that the Obama administration is ravaging Medicare with cuts aimed at paying for the Affordable Care Act. Both Romney and Ryan are prattling constantly about the “$716 billion cut” in Medicare, suggesting not so subtly that it’s money out of virtuous seniors’ pockets that’s going right to those people–you know, the ones Obama really cares about.

At WaPo’s Wonkblog this morning, Sarah Kliff usefully deconstructs the issue, noting that the famous $716 billion does not involve any benefit cuts, and is composed roughly in thirds of (a) reduced subsidies for the grossly expensive Medicare Advantage pet rock that Republicans have foisted on the program in a failed effort to show how competition could reduce Medicare costs; (b) lower reimbursement rates for hospitals, which supported this change in the expectation that ACA would give them more patients; and (c) miscellaneous reimbursement changes affecting hospitals and home health providers, among others, but again, not affecting benefits or the availability of services.

But aside from the misleading use of the term “cuts” in describing ObamaCare’s impact on Medicare, there’s a much bigger problem for Romney and Ryan: at least one version of Ryan’s own budget resolution that passed the House pocketed the exact same Medicare savings. Now Romney’s claiming he’ll put the money back, though it appears this may simply mean life will get so much better in a Romney administration that Medicare’s solvency will magically be extended.

So on top of the little problem of these “cuts” not being “cuts” and the hypocrisy of attacking “cuts” you have yourself endorsed, Romney and Ryan are also ignoring improvements in Medicare services and costs established by ACA, as noted by TNR’s Jonathan Cohn:

A smaller, but still significant, portion of the money is for seniors. It helps them pay for prescription drugs, by filling the “donut hole” in Medicare Par D coverage. It also eliminates out-of-pocket costs for annual wellness visits, some cancer screenings, and other preventative services. Those benefits have actually started already: In the first six months of this year, according to the Department of Health and Human Services, more than 16 million seniors took advantage of the free preventative care provision.

All that goes away if ACA is repealed.

Now it’s probably true that all these details are insignificant as compared to the intended effect of blowing so much smoke on Medicare that voters don’t really believe either side. Given Ryan’s vulnerability on the subject, that’s quite valuable. But it’s definitely worth remembering and mentioning every time you hear a Republican accuse Democrats of using “Mediscare” tactics. At least the benefit reductions warned of in connection with the Ryan budget are real, unless you think medical inflation is about to vanish and those vouchers or “premium supports” will actually keep up with costs.